"Unfortunately, in the heterosexual IV population ...they know they put themselves at risk. ... They still seem to feel that, 'I'm not a gay man. I'm not living in Manhattan. I'm not living in San Francisco. This isn't going to touch me.'"

Gazing out at the manicured lawns, cookie-cutter row houses and backyard sandboxes, you might not expect there is much work here counseling drug addicts who are HIV positive. But Richard Weinstein knows these are the trenches of an HIV hotspot.

According to the Long Island Association for AIDS Care (LIAAC), the Centers for Disease Control reports that Long Island has more AIDS cases than any suburban area in the entire country. So, there's a lot to be done.

An AIDS activist since the early 1990's, Weinstein now works for Nassau County's Department of Drug and Alcohol Addiction. He counsels people whose addictions put them at high risk for HIV infection.

From prevention and testing to a support group for people coping with AIDS, Weinstein's work runs the gamut of HIV and AIDS management. And though the work may sound gloomy, he says he hasn't ever dreaded going to work.

On the front lines

savvyHEALTH: When you test people for HIV, what are the words that you use to tell someone that he or she is positive?

Richard Weinstein: I tell them right off the bat, as soon as they sit down. There are no ifs, ands or buts. I just say, 'We got the result and unfortunately, it did come back positive. You did come in contact with the virus.' Then I wait for a reaction.

savvyHEALTH: And how do people react?

Richard Weinstein: Well, it depends on the individual. With women who are prostitutes who know that they were at very high risk, they almost expect it. Their attitude is, 'I knew that. I just needed to get a confirmation. So, where do we go from here?'

It's different for a heterosexual man who is having unsafe sex with women and just wants to know that he's negative, but it comes back positive. For the people who are not expecting it, they're in shock.

At first most people don't really talk much. We do follow-ups, because the goal if they are positive is to get them connected with the agencies that are important to them. Treatment is obviously the first thing.

savvyHEALTH: Do the people you are working with recognize that they are at risk?

Richard Weinstein: Unfortunately, in the heterosexual IV population, they know it, but it's still kind of subconscious. They know they put themselves at risk, but basically when they're coming to see me they're coming to get that negative result.

They still seem to feel that, 'I'm not a gay man; I'm not living in Manhattan; I'm not living in San Francisco. This isn't going to touch me.'

Especially on Long Island, it's such an underground population. You don't know as many people with HIV and they're not as visible. You feel much more isolated.

savvyHEALTH: What kind of support system do the people you work with tend to have?

Richard Weinstein: There are people who have burned every bridge and have nobody. But really, a lot of people do have some family members, whether it is a husband, wife, boyfriend or girlfriend. There are still people in their lives, generally, who they can turn to.

One of the things I say is, 'Tell one person that you're being tested. Just have that one connection.' Even the waiting period can be really difficult for people. Having one person know means that if you do come back positive you don't have to tell them, 'Oh, by the way, I took the test and I came back positive. All that is too much at once.

savvyHEALTH: Is there a difference between working with addicted people and working with others who have HIV or AIDS?

Richard Weinstein: Recovery alone is tremendously difficult. It's a huge obstacle and then you put the burden of HIV and AIDS on top of that ...

That's the thing. These people are in treatment and they could just leave. They can say, 'I'm positive? Well, forget it.' And just leave. Or they can have the opposite reaction and understand its time for recovery. They say, 'I'm positive. Wow, I really fucked up and I need to change this.' So, it can go either way.

At the methadone clinic support group, they're coming from a place of being powerless and hopeless. They're not self empowered to take charge and make changes in their lives because they're constantly in this fight against addiction.

HIV is much more overwhelming for them. They have other issues to deal with like poverty. A lot of the people on methadone are still active in other addictions. They're struggling. And then you throw HIV on top of that and you're actually dealing with two life-threatening situations. It really magnifies everything.

savvyHEALTH: What are some of the main issues that come up in the support group?

Richard Weinstein: Treatment, problems with medication, and problems with medication and methadone. A lot of HIV medications eat the methadone so that a methadone dose doesn't hold them as long.

Relationship problems, whether it be that they're both positive or one is negative ... sexual problems. A lot of people who come to this group are just very helpless.

They don't really grasp the possibility of turning their situation into a positive thing or using this as a stepping stone to something better. It's a lot of, 'How do I get out from under this?'

It seems to lead them rather than the other way around.

savvyHEALTH: What is the biggest challenge in helping addicted people cope with HIV and AIDS?

Richard Weinstein: I think the biggest challenge is the self-empowerment part  teaching people to say, 'I can do something. I can change this.' To get them all the access to information.

It's often the simple things ... A lot of them complain about the symptoms of their drugs and I try to tell them, 'Change your meds. Talk to your doctor, tell him what's going on.' But, they don't do that.

savvyHEALTH: With all the new hope and new treatments, AIDS is still a terminal illness. How do you cope, personally, with counseling people about such a serious issue?

Richard Weinstein: Well, everyone asks me that question because I've been working in this field for a long time. When you're in that situation, you learn to filter. I do it automatically.

I focus on what I did to help someone. I don't take home all the suffering. It's how my brain selectively holds on to things and lets go of others.

I'm not saying I don't have burnout days. I could lose a patient and have a moment of total grief. But, if I stayed in that all the time, I couldn't do my work.

savvyHEALTH: Can you describe a non-burnout day, a day when your work was particularly rewarding?

Richard Weinstein: Just recently I had a client who I gave a positive result who really needed a lot of my services. He kept coming down to my office to ask me questions.

He just left treatment and he thanked me for everything I'd done for him. He gave me a little necklace he made for me.

It's those little things that show, wow, someone really got something from me. When I do the support groups and the educational groups, everyone really seems to appreciate what I'm doing.

I can't say I ever get up and dread going to work, which is a huge benefit on my part. I love going to my job.

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